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Effective teamwork contributes to patient safety in the operating room (OR). For the busy rural surgeon, enhancing OR teamwork can be difficult. This manuscript describes results from the initial implementation of a preoperative briefing protocol at a rural community hospital. From July 2006 to February 2007, teamwork among OR staff working with a single general surgeon at a rural hospital in Alaska was evaluated before and after introduction of a preoperative briefing protocol. After each case, participants completed a questionnaire applying a 6-point Likert-type scale targeting effectiveness of both the preoperative briefing and OR team interaction. Mean values were calculated from 20 cases before introduction of the preoperative briefing and from another 16 cases after its introduction. Statistical analysis of the difference between pre- and post-protocol team performance was conducted with Student’s t test. Mean procedure times were calculated for matched cases pre- and post-intervention and were compared with Wilcoxon’s exact test. Ten members of the OR staff, including the general surgeon, completed both pre- and post-protocol questionnaires. Four additional members of the OR staff completed only pre-protocol questionnaires, and three additional members of the OR staff completed only post-protocol questionnaires. After implementation of the preoperative briefing protocol, the mean score of overall preoperative briefing was 1.01 units higher than before ( p < 0.0001), and overall OR team interaction was 0.50 units higher ( p < 0.0001). The overall mean post-intervention procedure time was shorter than the overall mean pre-intervention procedure time (31 ± 12 min versus 50 ± 18 min) for four categories of matched cases. Because of the small sample size, statistical significance was not achieved ( p = 0.057). Implementation of a preoperative briefing protocol improved overall preoperative briefing and OR team interaction in the study setting. These findings are encouraging for enhancing teamwork and patient safety through implementation of a systematic protocol. [ABSTRACT FROM AUTHOR]